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Eyecare Review— For Primary Care Practitioners

Eyecare Review— For Primary Care Practitioners. Primary Care Practitioners. See variety of eye problems Discuss treatment options Facilitate referrals Positioned to explain optometry's role as primary eye care providers. Outline. Anatomy Optics Turned Eyes Lazy Eye

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Eyecare Review— For Primary Care Practitioners

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  1. Eyecare Review—For Primary Care Practitioners

  2. Primary Care Practitioners • See variety of eye problems • Discuss treatment options • Facilitate referrals • Positioned to explain optometry's role as primary eye care providers

  3. Outline • Anatomy • Optics • Turned Eyes • Lazy Eye • External Conditions • Internal Conditions • Diabetic Retinopathy

  4. ANATOMY

  5. Basic Anatomy Choroid Sclera Retina Cornea Fovea Pupil Lens Optic Nerve Iris Ciliary Body

  6. Lids • Lashes—protection from foreign material • Glands—lubricate anterior surface • Meibomian glands • Glands of Zeis • Glands of Moll

  7. Conjunctiva • Thin, transparent, vascular layer lining • Backs of eyelids • Fornices • Anterior sclera

  8. Sclera • Tough outer shell • Composed of collagen bundles • Protects from penetration

  9. Cornea • Composed of regularly oriented collagen fibers • 5 layers

  10. Anterior Chamber • Space between cornea and iris • Filled with aqueous humor produced by ciliary body

  11. Iris • Iris gives eye color • 2 muscles: • Dilator—opens • Sphincter—constricts

  12. Pupil • Allows light to enter • Enables view to back of eye and eye health evaluation

  13. Lens • Located behind iris • Focuses light on retina • Allows for accommodation • Normally transparent • Where cataracts form

  14. Ciliary Body • Primary functions • Pulls on lens for accommodation • Epithelium secretes aqueous fluid that fills anterior chamber

  15. Red Reflex • Light reflection off retina • Useful for assessing media clarity • Affected by any opacity of cornea, lens, vitreous • White reflex = leukocoriaRefer immediately!

  16. Vitreous Humor • Gel-like fluid that fills back cavity • Serves as support structure for blood vessels while eye formed—before birth • After birth, just ‘hangs out’ in there • Where floaters are located

  17. Fundus • Interior surface of eye • Includes • Optic nerve • Retina • Vasculature

  18. Optic Nerve Head • Collection of nerve fibers and blood vessels from retina • Transfers info to brain’s visual cortex • Slightly yellow-pink when healthy • White ‘full moon’ appearance can mean trouble!

  19. Optic Nerve Head • Cup is natural depression in center of nerve • Cup size varies between people • Very large cup, or change in appearance over time, can indicate glaucoma Optic Disc Physiologic Cup Optic Nerve

  20. Macula • Dense collection of cone photoreceptors • Fine detail and color vision • Macular degeneration affects this area

  21. Retinal Vessels • Include arteries and veins • Only place in body where you can directly visualize blood vessels • Excellent indicators of systemic diseases • HTN • Diabetes • High cholesterol • Carotid disease

  22. Peripheral Retina • Can only be evaluated with dilated pupil • Important to evaluate periodically to fully assess eye health

  23. OPTICS

  24. Optics Review • Myopia • Hyperopia • Astigmatism • Presbyopia

  25. Myopia • Nearsightedness • See well up close but blurry in distance • Eye is too long • Light focuses in front of retina

  26. Hyperopia • Farsightedness • See well in distance • Eye is too short • Focus point is behind retina

  27. Hyperopia • Blurry image on retina • Lens focuses to compensate • Hyperopes often asymptomatic much their of lives • Can cause headaches or eyestrain with extended reading • These problems can get worse after age 40

  28. Astigmatism • Surface of cornea isirregular or misshapen • Light focuses at various points causing distorted vision • Often combined with nearsightedness and farsightedness

  29. Presbyopia • Normal, age-related change • Near vision becomes difficult • Mid-40s lens becomes less elastic and losesability to change focus • Time for bifocals…

  30. MISALIGNED EYES

  31. Eye misalignment One or both turn in, out, up or down Caused by muscle imbalance 3 Kinds of Strabismus Esotropia Exotropia Hypertropia Turned Eyes - Strabismus

  32. 1. Esotropia • Eye turns in towards nose

  33. 3 Types of Esotropia • Infantile (congenital) • Develops in first 3 months of life • Surgery usually recommended—along with vision therapy and glasses • Accommodative • Usually noted around age 2 • Child typically farsighted • Focusing to make images clear can cause eyes to turn inward • Treated with glasses but vision therapy may also be needed

  34. 3 Types of Esotropia • Partially Accommodative • Combination of • accommodative dysfunction and • muscle imbalance • Glasses and vision therapy won’t completely correct eye turn • Surgery may be required for best binocularity

  35. If you see Esotropia • Refer to pediatric optometrist or ophthalmologist • Sooner the better for best chance of good vision

  36. 2. Exotropia • Eye turns outward • Congenital—present at birth • Surgery usually needed to re-align • Many exotropias are intermittent • May occur when patient is tired or not paying attention • Concentration can force eyes to re-align • Vision therapy and/or glasses can help

  37. 2. Exotropia • When intermittent • Brain sometimes receives info from both eyes (binocular) • Less chance of amblyopia • However, important to be seen by eyecare provider when deviation noted

  38. 3. Hypertropia • One eye vertically misaligned • Usually from paresis of an extra-ocular muscle • Typically much more subtle for patient to describe and provider to diagnose

  39. 2 Types • Congenital • Most common type • Patients can compensate for years by tilting head • Can be discovered by looking at childhood photos

  40. 2 Types • Acquired • Trauma—Extra-ocular muscle ‘trapped’ by orbital fracture • Vascular infarct—Systemic diseases that affect blood supply to nerves can cause temporary nerve palsy • Diabetes and HTN most common • Palsies tend to resolve over weeks or months • Neurological—In rare cases a tumor or aneurysm can cause symptoms

  41. LAZY EYE

  42. Lazy Eye - Amblyopia • Decreased vision uncorrectable by glasses or contacts—not due to eye disease • For some reason, brain doesn’t fully acknowledge images seen

  43. 3 Types of Amblyopia Strabismic Anisometropic Stimulus deprivation Lazy Eye - Amblyopia

  44. 1. Strabismic Amblyopia • One eye deviates from other and sends conflicting info to brain • Brain doesn’t like to see double—so “turns off” info from deviated eye • Results in under developed visual cortex for that eye • Can usually be reversed or decreased if treated during first 9 years • Need to visit eyecare provider ASAP to determine cause

  45. Treatment • If caught early, treatment can teach brain how to see better • Vision therapy/patching • Glasses • Surgical re-alignment • Early vision screenings are critical!

  46. 2. Anisometropic Amblyopia • Anisometropia—significant difference in Rx between eyes • Commonly one eye more farsighted • Farsighted eye works hard to see clearly—and sometimes gives up • Brain relies on info from other eye

  47. 2. Anisometropic Amblyopia • If not caught, one eye won’t learn to see as well as other • Vision therapy and glasses are both beneficial • Sooner the better

  48. 3. Deprivational Amblyopia • Any opacity in visual pathway can be devastating to developing visual system • Congenital cataracts • Corneal opacities • Ptosis (droopy eyelid) • Other media opacities

  49. EXTERNALCONDITIONS

  50. Blepharitis Hordeolum—stye Preseptal cellulitis Orbital cellulitis Pterygium Corneal ulcer Conjunctivitis Viral “pink eye” Adenovirus Bacterial Allergic Hyperacute Chlamydial Common External Ocular Conditions

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